OmniPod DASH System - Page 7

7
1. Maximum Basal Rate _____U/h
_____ to _____ _____U/hr
2. Basal 1
_____ to _____ _____U/hr
Total Daily Basal ______U
_____ to _____ _____U/hr
_____ to _____ _____U/hr
3. Temporary Basal Rate On Off
(Select “On” if model UST400 is set
to % or U/Hr. “On” is in %)
4. BG Goal Limits Lower Limit_____mg/dL Upper Limit_____mg/dL
Find in model UST400: Settings>
System Setup>BG Meter>BG Goal
5. Suggested Bolus Calculator On Off
_____ to _____ Target_____ mg/dL Correct Above_____mg/dL
6. Target BG
_____ to _____ Target_____ mg/dL Correct Above_____mg/dL
_____ to _____ Target_____ mg/dL Correct Above_____mg/dL
_____ to _____ Target_____ mg/dL Correct Above_____mg/dL
7. Min BG – for bolus calculations _____mg/dL
_____ to _____ _____g/carb
8. Insulin-to-Carbohydrate (IC) Ratio
_____ to _____ _____g/carb
_____ to _____ _____g/carb
_____ to _____ _____g/carb
_____ to _____ _____mg/dL (1 unit of insulin decreases BG by)
9. Correction Factor
_____ to _____ _____mg/dL (1 unit of insulin decreases BG by)
_____ to _____ _____mg/dL (1 unit of insulin decreases BG by)
_____ to _____ _____mg/dL (1 unit of insulin decreases BG by)
10. Reverse Correction On Off
11. Duration of Insulin Action _____hours
12. Maximum Bolus _____U
13. Extended Bolus On Off
(Select “On” if model UST400 is set
to % or U/Hr. “On” is in %)
12am
12am
12am
12am